中重度冠状动脉钙化对介入治疗即刻疗效的影响

目的观察中重度冠状动脉钙化对冠状动脉介入治疗即刻疗效的影响。方法连续收集84例冠心病患者(84处靶病变),在冠状动脉支架置入术前后,通过血管内超声分析冠状动脉斑块特征、评估支架置入情况,并收集临床资料及介入操作相关信息,根据结果分为无钙化组36例和中重度钙化组48例,所有钙化病变均给予充分预扩张,并在血管内超声指导下视情况给予后扩张处理,对比2组PCI前后临床及影像学特征。结果 PCI后中重度钙化组置入支架直径、术后最小支架直径、最小支架横截面积、即刻管腔获得及相对管腔获得均小于无钙化组(P<0.05),PCI前中重度钙化组单支病变、靶病变B1型、斑块偏心指数、远端参考外弹力膜面积及管腔面积小于无钙化组(P<0.05,P<0.01)。而2组支架对称性、膨胀指数、手术并发症、院内主要不良心血管事件发生率比较,差异无统计学意义(P>0.05);2组术前最小管腔截面积、斑块负荷、管腔面积狭窄率、重构指数、病变长度差异无统计学意义(P>0.05)。结论血管内超声指导下给予充分预扩张及非顺应性高压球囊后扩张处理后,中重度钙化仍然影响PCI术后即刻管腔获得,但最终管腔面积基本理想。

Effect of moderate-severe calcified coronary lesions on immediate outcome of percutaneous coronary intervention

Objective To observe the effect of moderate-severe calcified coronary lesions on immediate outcome of percutaneous coronary intervention(PCI).Methods Eighty-four coronary heart disease patients with 84 target lesions were included in this study.Features of their coronary artery plaques were detected and stenting was assessed by intravascular ultrasonography(IVUS) before and after PCI.Clinical data and stenting-related information were collected.The patients were divided into non-calcification group(n=36) and moderate-severe calcification group(n=48).The calcified lesions were fully pre-dilated and post-dilated under the IVUS guidance.The clinical and imaging features were compared between the two groups before and after PCI.Results No significant difference was found in minimal lumen cross section area(CSA),plaque burden,lumen area stenosis,remodeling index and lesion length between the two groups before PCI(P>0.05).The standard stent diameter,minimal stent diameter,minimal stent CSA,acute lumen gain and relative lumen gain were smaller in moderate-severe calcification group than in non-calcification group after PCI(P<0.05).However,no significant difference was found in stent symmetry index,dilation index,procedural complications and incidence of major adverse cardiac events between the two groups(P>0.05).Conclusion Moderate-severe coronary calcified lesions affect the acute lumen gain even after IVUS-guided full pre-dilation and post-dilation with noncompliant balloon.However,the basically ideal lumen CSA can be achieved after PCI.